We are trained to exclude emotion in many situations, usually to our disadvantage.  I’ve found that the more I care…the more I seem to care.  It sounds odd and looks even more unusual in print, but I’ve found that those who build up an emotional wall completely are some of the first to crack.

But then again, those who engage completely break down even sooner.

The trick, I’m learning, is to know when to use that emotion to a desired result.

On a recent job we encountered an all too common condition that has a rather quick and easy remedy.  It was given and our patient awoke, rubbed his face, sat up and lit a cigarette as I’m sure he does every time he awakens to the sea of navy wool shirts with silver badges leaning over him.

His girlfriend, who found him unconscious, is in the hallway and in tears, crying so loudly we can barely hear each other talk during our treatments.  As we begin to realize the patient has no intention of going in to hospital, we do our best to convince him man to man.

When that fails we often take the Professional route.  My personal speech revolves around finding their trade, then making a fool of myself trying to explain it, then show them that they’re in my comfort zone and should trust my judgment.

On the rare occasion our powers of persuasion have failed we can default to kicking the decision upstairs and getting an MD on the phone to speak to the patient.  With an adult man explaining in clear sentences that he will only be removed from his home by extreme force, the MD is reluctant to give a transport order (which is uncommon) and now we can get an autograph and go in service.  And by go in service I mean get a cup of coffee before she calls back after he’s unconscious again after our treatments wear off.

Most times this is where my last ditch efforts are to literally beg, asking them to prove me wrong, daring them almost.  When the smoke was blown towards my face without a response and the crying in the hall continued I realized this man did not even see me there, just a uniform with a warm body in it.  A warm body who’s job it is to medicate him from time to time, then go away.  There would never be the personal connection I need to convince him of his condition and what needed to be done.

It was late and the entire building was awake, partly from our commotion, but mostly from the girlfriend crying in the hallway.  Wondering what would happen I brought her in, not to convince him to go or to have a heart to heart, but to teach her the basics of CPR and opening airways.

Cruel perhaps, but as I explained how to keep him alive later, after we had left, her hands were visibly shaking and she calmed down and listened carefully.  As our patient watched me teach her how to open his airway and keep him alive until we could arrive the next time, he saw what a burden he had been and would soon become.  As we explained hand position for chest compressions he rose, easily dwarfing my 6 foot 2 inch frame, and grabbed his jacket and shoes.

“Get your shoes, I’ll go.” he said as he put out his cigarette and walked towards me.

Half of me shreaked like my 5 year old and ran down the hall to survive.  The other half turned square, ready to defend my actions and took a breath in.

He brushed past me and into the hall, out the door and into the ambulance.

His girlfriend gave quick chase, grabbing a large bag on the way which rattled with a dozen pill bottles.

My emotional connection to this case was irrelevant, because no matter how much I invested in it, the results were not going to change.  But focusing on my patient’s state of mind and emotion, I can manipulate the environment for their benefit.

Did I trick him into going?  Some could argue yes.  Will the transport and evaluation really have any effect on his repetitive condition?  We already know the answer is no as countless transports in the past have shown.  But maybe, just maybe, showing him how much he impacts those that matter to him, not just telling him, will be the start of something.

I can only hope.

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